Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 39893 | CA |
NPI | 1730235607 |
---|---|
Provider Name | Dr. Shawn J. Summers |
First Address | West Hollywood, CA 90069-2085 |
Second Address | North Hollywood, CA 91605-5162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |